스웨덴 일차의료 영역에서 진료선택제도(vårdval) 도입의 효과

신정완 한국 스칸디나비아학회 2023 스칸디나비아 연구 Vol.31 No.-

Sweden has long been an exemplary country having NHS(National Health Service) type health security system. The Swedish health security system, however, has been much changed since 1990s by the policies marketizing healthcare. The introduction of the healthcare choice system(vårdval) is a pronounced case of the market-oriented healthcare reforms. This system enables patients to choose medical institutions where they would receive treatment and register themselves there. The county councils, responsible for healthcare, then reimburse each medical institution for the medical costs incurred, according to the number of registered patients of each medical institution. Some county councils voluntarily introduced this system since 2007. Since 2010, the introduction of the system in the primary healthcare became obligatory for all county councils. The system has produced good results such as the enhanced rights of patients, the improved responsiveness of the primary care centers to patients’ demands, the increase of the number of primary care centers, and the increased diversity of healthcare providers. But bad results also have been produced such as the widening gap of healthcare accessibility between population densed areas and population thin areas, and between patients with mild cases and patients with serious cases, and the fact that patients with complex diseases can not receive well-integrated treatment as before. We can say that the healthcare choice system brought out results violating the healthcare egalitarianism, the traditional value of the Swedish healthcare, in that the patients with stronger healthcare needs came to be in worse situation. The main causes of these bad results are as follows. Firstly, the system brought out results that healthcare providers choose patients, rather than patients choose medical institutions as intended. Secondly, the principle of equal treatment for all healthcare providers made it difficult for county councils to selectively support the medical institutions in the backward areas in healthcare. 스웨덴은 NHS(National Health Service) 유형의 의료보장체계를 가진 대표적 나라의 하나였으나, 1990년대 이후 의료 시장화 정책을 추진하여 의료보장체계의 성격이 크게 변화했다. 진료선택제도(vårdval) 도입은 시장주의적 의료 개혁의 대표 사례라 할 수 있는데, 이 제도는 환자가 의료기관을 자유롭게 선택하여 등록하게 하고, 의료기관별 등록환자 수에 따라 광역지자체가 의료기관에 의료비를 보상해주는 제도다. 2007년부터일부 광역지자체가 이 제도를 도입했고 2010년부터는 일차의료 영역에서 모든 광역지자체가 이 제도를 의무적으로 도입하게 되었다. 진료선택제도의 성과로는 환자의 권리 신장, 환자의 요구에 대한 의료기관의 민감성 제고, 일차의료기관의 수 증가, 의료공급자의 다양성 증가를 들 수 있다, 부작용으로는 인구밀집지역과 인구희소지역 간에, 그리고 경증환자와 중증환자 간에 의료접근성 격차가 벌어지고, 복합적 질환을 가진 환자들에 대한 통합적 진료가 어려워진 점을 들 수 있다. 제도 도입 이후 의료의 객관적 필요가 큰 사람들의 처지가 악화되었다는 점에서 스웨덴 의료의 전통적 가치인 의료 평등주의를 훼손했다고 볼 수 있다. 이런 결과가 나오게 된 핵심 원인으로는, 환자가 의료기관을 선택하도록 한다는 제도 취지와는 달리, 여러 요인으로 인해 실제로는 의료공급자가 환자를 선택하는 측면이 강했다는 점, 그리고 이 제도의 구성요소의 하나인 모든 의료공급자에 대한 동등대우 원칙으로 인해 의료낙후지역의 의료기관들에 대한 선별적 지원이 어려워졌다는 점을 들 수 있다.

장애인의 의료기관 접근성은 향상되었는가? - 서울시 종로구 병의원을 대상으로 -

이진용,정재영,김유경,전은경,김소윤,김현주,이보우 한국보건행정학회 2012 보건행정학회지 Vol.22 No.4

The purpose of this study was to evaluate the improvement of disabled access to healthcare institution located in Jongno-gu, Seoul in 2011 compared to 2003 since disabled access has been mandatory in healthcare institutions located in new buildings by the amended law in 2004. We had investigated 10 assessment items for disabled access in 166 healthcare institutions located in Jongno-gu, Seoul and the results were compared with those of 2003 survey. On average, 74.1% of the healthcare organizations has equipped with items for disabled access. However the adequately equipped rate for those items was only 39.2%. Compared with the results of 2003 survey, these rates showed a little increase by 4.1% and 8.0%, respectively. There were only 10 healthcare institutions located in new buildings which were constructed after July, 2005. Their average equipped rate(84.4%) and adequately equipped rate(46.8%) were higher than those of the other organizations because the Korean government ruled that healthcare institutions in new buildings must have facilities for the disabled. In conclusion, we confirmed that the accessibility of the disabled to healthcare institution slightly increased. In particular, the healthcare institutions in newly constructed building showed the significant increase of accessibility of the disabled. However, it is founded that disabled access is still not enough for the disabled.

에이전트 기반 모델링을 활용한 소아・청소년 의료 서비스 취약지 분석 - 서울 서남권 4개 자치구를 대상으로 -

김수빈,이승연,김민주,이창규,강전영 대한지리학회 2024 대한지리학회지 Vol.59 No.2

한국은 출산율 저하와 이로 인한 급격한 소아 의료자원 감소를 겪고 있다. 이로 인해 소아청소년과 진료 대란이 발생하면서 소아 의료 체계 붕괴가 가속화되고 있다. 이러한 위기는 사람들의 의료서비스에 대한 접근성을 약화하고 공간적인 불균형을 심화할 수 있다. 기존의 의료서비스에 관한 접근성 연구들은 환자 개인의 행동 패턴과 환자들의 발병, 이동, 대기, 진료 등 일련의 프로세스를 동적으로 반영한 공간적인 접근성을 반영하지 못한다. 이에 본 연구에서는 에이전트 기반 모델링을 활용하여 동적인 환경에서 환자 개인의 행동 패턴과 진료 과정 전반을 고려해, 소아청소년 의료서비스 취약지를 탐색하였다. 지리적 인접성을 기반으로 하는 실질적인 취약지를 탐색하기 위해 핫스팟, 콜드스팟 분석이 진행되었다. 그 결과, 의료서비스 인프라의 공간적인 불평등을 확인할 수 있었고 환자 개인의 행동 패턴과 진료 과정 전반을 고려해 공공의료 제언을 위한 분석 결과를 도출할 수 있었다. In South Korea we are currently facing with a decline in fertility rates and a significant reduction in pediatric healthcare resources. As a result, there is a shortage of pediatric care, which may be responsible for accelerating the collapse of the healthcare system for pediatric patients. This crisis may undermines an access to healthcare and spatial disparities in the access. Previous studies on healthcare accessibility have not adequately considered spatial accessibility, which is associated with the individual behaviors of patients and their arrival, movements, waiting, and treatment processes. To address this issue, in this study, we used an agent-based modeling to explore vulnerable areas for pediatric healthcare services while incorporating the entire processes of movements and treatment for individual patients in a dynamic environment. We take four districts in Southwest Seoul as a study area. A hot and cold spot analysis was conducted to identify actual vulnerabilities of pediatric healthcare services. The results help to assess the spatial inequalities in medical infrastructure, which in turn, supports decision making processes for stakeholders to newly install additional pediatric healthcare services.

중국의 지역 환경과 온라인 의료 플랫폼 이용

Xingyu Wu,손정민 사단법인 한국융합기술연구학회 2023 아시아태평양융합연구교류논문지 Vol.9 No.10

의료 서비스 인프라는 일반적으로 대도시에 집중되어 있으며, 도시에서 멀리 떨어진 교외 거주자는 의료 서비스에 대한 접근성이 상대적으로 낮을 수 있다. 중국에서는 이러한 격차를 메우기 위한 보완 수단으로 온라인 의료 서비스 산업이 급속히 성장하고 있다. 온라인 의료 서비스에 대한 이전의 연구에서 의사 및 병원의 특성, 질환의 유형, 환자들 사이의 구전, 그리고 전문 지식의 공유 정도 등의 요인이 환자의 온라인 의료 서비스 의사결정을 설명하였지만, 온라인 플랫폼이 오프라인 의료서비스를 대체하는 이유에 대한 체계적인 설명이 부족한 편이라고 할 수 있다. 이 연구의 목적은 온라인 의료 수요에 영향을 주는 오프라인 환경 요인으로 교외 효과에 대해 설명하는 것이다. 또한 교외 효과를 더욱 구체적이고 다차원적으로 확인하기 위해, 교외 효과와 관련이 있는 접근성(i.e., 거주지역의 면적), 서비스 공급(i.e., 지역의 병상수), 그리고 진료과목 소수자(i.e., 진료과목의 상대적 비율)의 상호 작용 효과에 대해 분석하였다. 분석데이터는 중국의 대표적인 온라인 의료 서비스 플랫폼 중 한 곳을 통해 의사의 프로필, 온라인 환자의 평가 등과 같은 다양한 온라인 진료 기록 및 의사 특성 변수를 수집하였다. 오프라인 환경의 효과를 분석하기 위하여 중국 각 도시의 인구, 면적, 병상수 등을 수집하였다. 최종적인 분석에는 의료 플랫폼 데이터와 인구통계 데이터를 결합하여 이용했다. 실증 분석 결과로, 교외 지역 거주자의 비율이 높을수록 온라인 의료서비스 이용 가능성이 더 높았다. 또한 지역의 접근성과 진료과목의 소수자는 교외 효과를 강화시키고, 의료 공급은 교외 효과를 약화시키는 상호작용이 있었다. 이 연구는 오프라인 환경과 온라인 의료 플랫폼 사이의 관계에 관한 학술적 연구 분야를 발전시키는 데 기여하고, 병원, 온라인 의료 플랫폼, 의사에게 새로운 실무적 시사점을 제공하고자 한다. In generally, healthcare infrastructure is typically concentrated in large cities, with suburban residents living farther away from cities facing inequalities in access to healthcare. Online healthcare is growing rapidly as a complementary means to fill this gap in China. Previous studies on online healthcare have found that factors such as physician and hospital characteristics, type of disease, oral communication among patients, and the degree of expertise sharing explain patients' online healthcare decisions, but there is a lack of systematic explanation of why online platforms are replacing offline healthcare. The purpose of this study is to explain the suburban effect as an offline environmental factor that affects the demand for online healthcare. To make the suburban effect more specific and multidimensional, we also analyze the interaction effects of accessibility (i.e., area of residence), service supply (i.e., number of beds in the region), and department minority (i.e., relative proportion of specialties) that are related to the suburban effect. To empirically analyze the above effects, this study collects various online medical records and physician characteristics variables, such as physician profiles and online patient ratings, through medical service platforms. To analyze the offline characteristics, we used the China Urban Statistics Yearbook 2022, which contains the population, area, and number of beds of each city in China. The healthcare platform data and demographic data were combined and analyzed. The results of the empirical analysis are as follows: the higher the proportion of suburban residents, the more likely they were to visit a doctor online. At the same time, regional accessibility and specialty scarcity can reinforce the suburban effect, while medical supply reduces the suburban effect. The study has new practical implications for hospitals, online healthcare platforms, and physicians. Hospitals are expected to maximize the efficiency of resource allocation through online regional differentiation strategies. Medical platforms can also reduce marketing costs and maximize user diffusion and usage through regional differentiation strategies depending on the level of online medical demand in each region. For doctors in minority subjects, online medical platforms are expected to be able to attract patients from across the country.

Identification of Unmet Healthcare Needs: A National Survey in Thailand

Chongthawonsatid, Sukanya The Korean Society for Preventive Medicine 2021 Journal of Preventive Medicine and Public Health Vol.54 No.2

Objectives: This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand. Methods: The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis. Results: Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were-in descending order of frequency-insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors. Conclusions: Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.

Securing Child Information Access Control in Ubiquitous Healthcare Systems

Rosslin John Robles,Kyung Jung Kim 보안공학연구지원센터(JSE) 2011 보안공학연구논문지 Vol.8 No.1

In developed and developing countries, Ubiquitous Healthcare technology is gaining much attention. Many new projects are based on Ubiquitous Healthcare. It has provided a lotof answers to the current problems of the medical as well as the computing area. However, Security in Information Access for the patients especially children can be easily accessed. In this paper, we consider security issues due to increasing access sharing of patient information resources in the networked environment. A new efficient access control in order to provide various security characteristics, such as authentication, confidentiality, integrity and non-repudiation for ubiquitous systems is proposed.

국민건강보험 이용자의 의료전달체계 인식에 따른 진료의뢰 개선 방안

정영권(Young Kwon Jeong),서원식(Won Sik Suh) 한국산학기술학회 2016 한국산학기술학회논문지 Vol.17 No.12

이 연구는 국민건강보험 이용자의 입장에서 의료전달체계에 대한 인식에 따른 진료의뢰 개선방안을 제시하기 위해 수행되었다. 국민건강보험 이용자가 1단계 의료기관에서 진료의뢰서를 받아 서울에 소재한 S대학병원(소위 ‘빅 4병원’중 한곳)을 방문한 207명의 외래환자를 대상으로 설문조사를 하였다. 설문 신뢰도는 Cronbach’s α가 0.7이상 이었고 연구방법은 인구학적인 특성은 pearson카이제곱과 Fisher’s exact 검정을, 인식도와 개선요구도 간에는 pearson상관 분석을 실시하였다. 연구결과, 내원환자의 5.9%가 상급종합병원에서 의뢰되어 상급간의 의뢰를 확인하였고, 병원선택요인은 의사의 명성과 신뢰(4.40±.92)가 가장 높았다. 진료의뢰제도에 대해 서울의 대형 상급종합병원으로 쏠리는 현상을 가장 높게 인식하였고 (4.24±.97) 서울의 대형 상급종합병원으로의 집중화현상이 최우선 개선과제로 나타났다(4.05±1.02). 의료전달체계의 인식도와 개선요구도의 상관계수가 0.326으로 매우 유의미한 양(+)의 상관관계를 보였다(p<.01). 이번 연구를 통해 향후 의료전달체계 개선 시 공급자나 보험자가 아닌 이용자중심의 제도개선이 이루어지기를 기대해 본다. This study was carried out to suggest hospital referral system improvements based on health insurance subscriber perceptions of the delivery of healthcare. Health insurance subscriber outpatients (n = 207) referred from a stage 1 medical institution to the S university hospital located in Seoul responded to the study survey. The study"s item reliability is reliable as the Cronbach"s alpha coefficient was greater than 0.7. This study results showed that 5.9% of patients were referred from a higher stage hospital to a same stage hospital. The main factor attracting patients to S university hospital were physician reputation and confidence. The highest factor (4.40 ± .92) was xxxx. In addition, survey respondents reported that the concentration of patients in extra-large hospitals in Seoul (4.24 ± .97) was an important issue, and the issue with the highest priority for improvement (4.05 ± 1.02). A positive correlation was detected between the recognition and improvement of delivery of healthcare (p < 0.01). Based on the results, we suggest that improvements in the delivery of healthcare should focus on patients rather than suppliers of national health insurance or other insurers.

Securing Child Information Access Control in Ubiquitous Healthcare Systems

Rosslin John Robbles,김경중 보안공학연구지원센터 2011 보안공학연구논문지 Vol.8 No.1

In developed and developing countries, Ubiquitous Healthcare technology is gaining much attention. Many new projects are based on Ubiquitous Healthcare. It has provided a lotof answers to the current problems of the medical as well as the computing area. However, Security in Information Access for the patients especially children can be easily accessed. In this paper, we consider security issues due to increasing access sharing of patient information resources in the networked environment. A new efficient access control in order to provide various security characteristics, such as authentication, confidentiality, integrity and non-repudiation for ubiquitous systems is proposed.

한국에서 귀환한 네팔 이주자의 노동과 건강 경험

김경학 한국외국어대학교 인도연구소 2024 남아시아연구 Vol.29 No.4

Nepalese migrant workers work in the 3D industry, which is shunned by the Korean labor force, and face various health problems, especially due to precarious working conditions. This is a qualitative study that explores the factors that influence the physical and mental health of Nepali migrant workers in various work environments in Korea over a period of 5 to 10 years, both during their stay in Korea and after their return to Nepal, using narratives of migrants' personal experiences with health rather than medical indicators. In fact, the health of migrant workers is influenced by multiple factors that occur during all stages of migration, from the pre-migration stage to the stay in Korea and the return stage. The Nepali return migrants in this study experienced varying degrees of health problems, including musculoskeletal, digestive, and respiratory, in Korea and in Nepal after returning home. Social determinants affecting the physical and mental health of Nepali migrant workers included factors arising from migration itself, such as racial and ethnic discrimination against migrants, limited length of stay and insecurity of stay, limited Korean language proficiency, systems that prevent free movement, working conditions such as long hours, and limited access to healthcare. Of the 11 total migrants, two undocumented migrants experienced a health crisis due to limited social protection and risk of exploitation due to their legal status. Some migrants who returned to Nepal sought to recover physically and mentally through a combination of local and global practices, including yoga, Ayurvedic medicines, and Ceragem thermal massage, in addition to medication. Given the lack of a national health insurance system in Nepal and the financial resources required to access high-quality private healthcare, the 'migrant labor effect' of accumulating assets in a short period of time through migrant labor in Korea may lead to improved health in midlife for these returnees in the long run. 네팔 이주노동자들은 한국 노동력이 기피하는 3D 업종에서 일하며, 특히 불안정한 노동 조건으로 다양한 건강 문제에 직면한다. 이 연구는 한국의 다양한 작업 환경 속에서 네팔 이주노동자의 5~10년여 기간의 노동 경험이 한국 체류 기간과 네팔 귀환 이후 이주자의 신체·정신적 건강에 영향을 주는 요인들을 의학적 지표가 아닌 이주자의 건강 관련 개인적 경험의 서술자료에서 모색하는 질적 연구이다. 사실 이주노동자들의 건강은 이주 전 단계부터 한국 체류 단계 및 귀환단계에 이르는 모든 이주 단계에서 발생하는 여러 요인의 영향을 받는다. 이 연구의 네팔 귀환 이주자는 한국과 귀국 후 네팔에서 근골격계, 소화계통, 호흡기 등 건강상 문제를 다양한 수준으로 경험하였다. 이주 자체로 발생 되는 요인들, 즉 이주민에 대한 인종·민족적 차별, 제한된 체류 기간과 체류 불안정, 한국어 구사력의 한계 외에도, 자유로운 이직을 막는 제도, 장시간 근무 등의 근무 환경, 제한적인 의료서비스 접근성 등은 네팔 이주노동자들의 신체적, 정신적 건강에 영향을 미치는 사회적 결정 요인들로 작용하였다. 11명의 전체 이주자 가운데 미등록 이주자 두 명은 법적 지위로 인한 제한적인 사회적 보호와 착취 위험으로 건강 위기를 경험했다. 네팔로 귀환한 이주자 일부는 약물 치료 외에 요가, 아유르베다 약, 세라젬 온열 마사지 등의 로컬과 글로벌 병합 방식으로 신체적, 정신적 회복을 위해 노력하고 있다. 전 국민 대상 국가건강보험이 정착되지 않아 수준 높은 민간 의료서비스를 받기 위해 필요한 재원이 요구되는 네팔 현실을 감안하면, 한국 이주 노동으로 단기간에 자산을 축적한 ‘이주 노동의 효과’는 장기적으로 볼 때 이들 귀환자 중년기의 건강 개선으로 이어질 수 있을 것으로 생각된다.

Accessibility and site suitability for healthcare services using GISbased hybrid decision-making approach: a study in Murshidabad, India

Parvin Farhana,Ali Sk Ajim,Hashmi S. Najmul Islam,Khatoon Aaisha 대한공간정보학회 2021 Spatial Information Research Vol.29 No.1

Healthcare accessibility and site suitability analysis is an elongated and complex task that requires evaluation of different decision factors. The main objective of the present study was to develop a hybrid decisionmaking approach with geographic information systems to integrate spatial and non-spatial data to form a weighted result. This study involved three-tier analyses for assessing accessibility and selecting suitable sites for healthcare facilities, and analysing shortest-path network. The first tier of analysis stressed the spatial distance, density and proximity from existing healthcare to find more deprived and inaccessible areas in term of healthcare facilities. The result revealed that spatial discrepancy exists in the study area in term of access to healthcare facilities and for achieving equal healthcare access, it is essential to propose new plans. Thus, require finding suitable sites for put forward new healthcare service, which was highlighted in the second tier of analysis based on land use land cover, distancing to road and rail, proximity to residential areas, and weighted overlay of accessibility as decision factors. Finally, in the third tier of analysis, the most suitable site among the proposed healthcare was identified using the technique for order of preference by similarity to ideal solution. The road network analysis was also performed in this study to determine the shortest and fastest route from these healthcare facilities to connect with district medical hospital. The present study found some suitable sites throughout the district on inaccessible zones where people are deprived from better healthcare facilities. This attempt will highly helpful for preparing a spatial decision support system which assists the health authorities regarding the healthcare services in inaccessible, underprivileged, and rural areas.